Former hospital system executive, wrote hacking healthcare for O'Reilly, created the open source ClearHealth/HealthCloud EMR...
One of the few times in managing hospital systems I was actually shocked at unethical behavior was when we took over management of a system that through accidents of history included a series of dentistry clinics. Dentists do not have any equivalent to a hippocratic oath, they have no professional obligation to be honest with their "patients". The overriding operational theme of the clinics was how to defraud "patients" with completely unecessary work to maximize profits and borderline defraud dental insurance. I understand that people have a dim view of ethics in american healthcare but this was what I would consider criminal behavior in a medical setting but as further experiences taught me, is the norm in american dentistry. Suffice it to say that we divested from the dentistry clinics asap.
Here is one swiss study showing that 30% of dentists committed fraud in the studed visits or were so incompetent that their behavior constituted fraud. I would guess that american dentistry is closer to 50%.
Have you had your wisdom teeth out? You are very likely to be the victim of dental fraud.
As if that meant something for regular doctors. Agree with all your post and would like to share a some anecdata in case it's good for anyone here someday.
When I was around 16 I lost a premolar (I had an extra one, that messed up the real one, both died and fell down), all dentists immediately suggested I get an implant. Reasons given where:
* Your face will deform (no, really) because of your missing tooth
* Your other teeth will start moving and will get misaligned and fall as well
* Your bone around that area will disappear and you'll need a bone graft and you could die
I read a bunch about that online and came to know that implants do massive damage to your mandible and that's not to be taken lightly. Average implant life, if all goes well, is ~20 years, then you have to do it again, each time you do it you weaken your mandible and palate bones significantly. Back then I thought, in 20 years I'll be in my 30s, nowhere near being old and I would start having issues with this for life. I decided not to get it, and guess what? I'm 37 now and have never had a single problem because of that, ever. Every single time I go to a dentist I get the same speech, over and over, "get an implant or you'll die, do you want me to book the appointment now?" "no, I just want some cleaning done, thanks". Dentists are as unscrupulous as it can get.
Almost the same exact situation. Broke my premolar in a swimming pool accident when I was teen and forgot about it. Turned 25 and every dentist wanted an implant saying my face will deform, jaw will deform in couple of years etc.
More than 15 years have passed and my jaw line is better than ever.
In canada, if the dentist find out you have private health insurance its a free for all loot. They even insist of x-ray every 6 months. Very infuriating.
Yes but also the technology at my dentists office is 20 years ahead of the medical profession.
My Dentist has 3D imaging done in seconds during every visit, 3D printers so you they have a crown done same day, lasers to prevent scarring, ultrasonics. They’re using tools, chemicals, adhesives, and methodologies that are cutting edge. I have no doubt that a decade from now they’ll be growing and implanting replacement teeth.
Meanwhile, American doctors are still arguing about the value of preventive healthcare, refuse to use diagnostic tools, scoff at MRIs and imaging, won’t prescribe new drugs (GLP-1s), and struggle to use computers. And for the privilege of dealing with this entitled, technically illiterate industry costs insane amounts of money due to the AMA monopoly and artificial shortages of doctors. It’s really the biggest scam there is.
Dentists, at least from what I've observed, seem to kit out their offices once, when they initially hang out their shingle and then use it until they retire with only minor upgrades. So if you go to a younger dentist, they have new stuff, if you go to an older dentist they'll have old stuff. It might be different if you go to a dental franchise where a parent company owns and manages equipment, but most dental offices still seem to be one or a few practitioners that own the office around here.
Doctors don't have to organise themselves in a way that results in them providing cheap and effective healthcare services - they just need to monopolise enough so that nobody dares to go to somebody who isn't a real doctor. You mentioned prescribing new drugs - monopolising prescriptions alone is a huge reason to go to a real doctor. Think you know more? It doesn't matter if you do!
Just the way things are. There's a reason firemen are more popular than doctors.
One thing I really like about my current dentist is that they'll show me the imaging and explain things such as while a certain crack on the surface of a molar could be filled, there is no rot beneath it so we can just monitor it. Wisdom teeth is a great example, I used to go to a dentist when I was a kid that would always bring them up. I never got them removed and have never had problems with them. I'm sure it's one of those things where statistically a lot of people do have problems and it's also easier to remove them before they get impacted, but far too many dentists want to remove them using those statistics instead of basing it on the specifics of the individual patients.
My dentist said that the purpose of semiannual visits is to bug patients on a regular basis to brush and floss properly. People will treat oral hygiene like going to the gym: they'll be all pumped up for a bit and then slack off eventually. The six-month mark is about when most people need that kick in the arse to get back on track.
Scientists have been learning how crucial and vital good oral health is, because it affects the health of every other organ system in the body. Periodontal disease is a direct cause of both diabetes and heart disease. They even recently learned that poor gum health is a causal factor in colorectal cancer.
And flossing has ... not been shown to improve anything at all really. Which is why I truthfully tell every dentist that asks: No I did not floss a single time since the last time you told me to.
Also: My dad never really brushed his teeth much if at all. No fillings ever. No teeth removed. He used toothpicks "relentlessly" (in the XP sense) like while on the couch, while thinking through some chess moves etc. Turns out that's how our (smart) ancestors "brushed": with sticks.
> Turns out that's how our (smart) ancestors "brushed": with sticks
If you're eating the diet our prehistoric ancestors ate, are at their level of physique and generally okay with their life expectancy, this is fine advice. For everyone else, there is limited evidence it helps prevent gum disease and halitosis [1].
Yes that's two different ways to say the same thing.
With respect to flossing, this shouldn’t have been news either. A systematic review in 2011 concluded that, in adults, toothbrushing with flossing versus toothbrushing alone most likely reduced gingivitis, or inflammation of the gums. But there was really weak evidence that it reduced plaque in the short term. There was no evidence that it reduced cavities. That’s pretty much what we learned recently.
Different types of bacteria cause cavities as opposed to those causing periodontal disease. The former are caused by obligate aerobes, the latter by facultative anaerobes and are far more dangerous. The purpose of flossing is to get at the plaque (which forms tartar within 1-3 days) that exists interdentally and below the gum-line.
Flossing also hasn't been shown to not prevent tooth decay. (I.e. there is not much data to support one way or the other.) Also, some people don't carry the bacteria that create acid in their mouths, so (by chance) they don't need to floss/brush as much. Your dad might have been one of those people. If I don't brush or floss, I get like 5 cavities in 6 months. And my breath smells awful.
It's like type systems and productivity: we don't have a lot of data to say whether type systems make people more productive or not, but there are ton of SWEs who think that type systems make them more productive, and they are probably right (at least for their domains). Dentists, in their anecdotal experience, probably see patients improve once they start flossing and brushing. That's why they suggest it.
The last time I had my teeth cleaned, the hygenist kept mentioning how good I must floss and that I only missed one or two areas and even then they were trivial to clean. Finally after 3-4 times of hearing how great I flossed I finally broke down and told her that I never floss, beyond occasionally using one of those flosser sticks as a toothpick, but never with any regularity. She just couldn't believe it.
> And flossing has ... not been shown to improve anything at all really.
Blows my mind every time I this kind of nonsense. "Never been shown"? It has been shown to me. If in slack my flossing enough soon enough bits of food get stuck in between the teeth and gun and start rotting. When youve had breath smelling like rotten food you start being more meticulous with your flossing. I have to presume that you have awful breath and are unaware.
Try stopping the flossing and using toothpicks instead. They go in between as well as once they feather out they become tooth brushes. The only things missing are the actually good ingredients of modern toothpaste.
I also do hope that since Covid everyone with bad breath knows they have it. Except for anti maskers I guess.
Replacing flossing with diligent tooth picking is a lot different than not flossing. Most people don’t use a tooth pick or floss. If you don’t do either, you’ll probably show improvement from the act of caring to clean your teeth.
Wait, weren't you just making the case that flossing "has not been shown to do anything"? If it hasn't been shown to do anything, why would you suggest I replace it with something else?
You said you were not OK to not do it and that bits of food get stuck etc. Thus I suggested you might just try toothpicks instead if you really can't go without and insist that flossing is the only way.
I also mentioned copious use of toothpicking in my original post, though mostly as a replacement for some of the brushing.
Flossing is faster but it would be an extra step / thing to do at the end of the day (the recommended daily flossing). In the way I told my parent here to try replacing that, you're correct. Flossing would be faster!
In the original comment I made about toothpicking by dad, I'm wasn't talking about using a toothpick to just get some food that's stuck out. Everyone uses that from time to time I suppose. And also not as a floss replacement task at the end of the day. The kind of toothpicking I mentioned that he did was basically "automatic" and while doing other stuff. Basically a way to keep your hands occupied while otherwise idle and not as a specific "do this X minutes every day as part of your brushing routine".
Less painful: That really depends as well. The flossing the dentist does is super painful. I hate it when they do that. Using a toothpick? Not painful at all. I don't poke it into the gums. What do you do?
Thorough: Potentially, I'll give you that. It can reach some parts that toothpicks never will be able to I suppose. Then again, those are the parts in my experience where the floss gets stuck, feathers out and bits stay in between the teeth and you gotta try to get them out with yet more floss. They're also the parts that make flossing painful because you have to apply so much force to get the floss through that it tends to hit the gum line. That hurts. It's why it sucks so much when the dentist does it. If you do it yourself you at least have a bit of control and will be able to try to avoid that. But the dentist just wants to get through the flossing as fast as they can, so they really jam it in there and pull it down hard.
You likely find the dentist's flossing painful because you don't floss. It is not painful if you floss regularly (even just once a week) because it gets your gums used to the sensation and clears out the gunk that makes gums sore and sensitive. If your gums are in good condition (not inflamed from plaque), the floss will slide down between the tooth and the gum, rather than hit the gum directly.
I find toothpicks painful because they are wider and shaped like a wedge, and so they tend to push some food in deeper (like the thin, hard fragments that come from eating popcorn). Instead I use very thin, tape-like floss, which is minimally invasive and does not get stuck. It functions more like a scoop, slipping neatly under trapped food so it can be lifted out.
I also do flossing as an idle activity. I keep floss in the shower and at my desk. I almost never floss when I brush my teeth (can't be bothered) and only floss while I'm occupied with something else, like watching a show or waiting for hair conditioner to soak in.
Floss gets into the tight spaces between the teeth that a toothpick cannot reach. Toothpicks are a useful adjunct for flossing, but by no means a replacement.
Sorry, but unless one is blessed with near-perfect genetics, oral hygiene is real work. But it's worth it if you want to stay in good overall health into old age.
I'll make it even more general. Any chronic inflammation leads to insulin resistance. It's just that with modern western diets, oral inflammation is the one that is almost universal.
Yes I have noticed the dentist trying to x-ray my kids every six months. The dentist office near my university would basically point blank tell the students to get the works every visit because "aren't you covered by your student plan?". Yes I am a anti dentite
The part that really engenders distrust of the dental industry is that I’ll get three very different opinions from three dentists.
I should write a long post because any time the topic comes up I have a lot to say, but don’t want to wear my thumbs out on my phone. What they did and then further tried to do to my children made me violently livid and completely disenchanted with the industry.
Never thought I’d be a conspiracy theorist type person about anything but I do not trust dentists.
Yep, I basically stopped going to one dentist when something felt wrong decades ago when he said it was a cavity to be drilled; second opinion said it was definitely not (I didn’t tell him this was a second opinion). Since then I always get 2 or 3 opinions for me and my family if any of us go (definitely not every 6 months); none of us has any cavities or anything else wrong with us: we do brush and floss and none of us eats particular bad food for oral health.
I am quite sure there are a very large amount of people who had cavities drilled that never had to be.
If you have complex medical issues, you may not find much better results from doctors. It actually may be even more infuriating to be told you medical issues are just in your head.
I, for one, cannot wait for medical AI and ML models to be well-suited enough to summarize, suggest and potentially even diagnose patients based on data correlations and conclusions from other patient journeys.
I grow tired relying on the potential laziness, ignorance, apathy, and complacency that a doctor might have to help me - or even their own prerogatives getting in the way of their treatment and care.
Something more objective, unbiased and empirical would be nice. I often wonder how many lives would have been improved - or saved - if we achieved such technology sooner.
This is so subjective. Some have the right genes and behavioral patterns and can get by going on every year or two, while others need more upkeep to maintain their oral health.
One of the few times in managing hospital systems I was actually shocked at unethical behavior was when we took over management of a system that through accidents of history included a series of dentistry clinics. Dentists do not have any equivalent to a hippocratic oath, they have no professional obligation to be honest with their "patients". The overriding operational theme of the clinics was how to defraud "patients" with completely unecessary work to maximize profits and borderline defraud dental insurance. I understand that people have a dim view of ethics in american healthcare but this was what I would consider criminal behavior in a medical setting but as further experiences taught me, is the norm in american dentistry. Suffice it to say that we divested from the dentistry clinics asap.
Here is one swiss study showing that 30% of dentists committed fraud in the studed visits or were so incompetent that their behavior constituted fraud. I would guess that american dentistry is closer to 50%.
Have you had your wisdom teeth out? You are very likely to be the victim of dental fraud.
https://pubmed.ncbi.nlm.nih.gov/3135372/ https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3036573
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